Healthcare Provider Details

I. General information

NPI: 1457311045
Provider Name (Legal Business Name): CHESAPEAKE DERMATOPATHOLOGY & DERMATOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4234 GUM POINT LN
GLOUCESTER VA
23061-3639
US

IV. Provider business mailing address

PO BOX 969
WHITE MARSH VA
23183-0969
US

V. Phone/Fax

Practice location:
  • Phone: 757-439-2366
  • Fax: 757-693-9404
Mailing address:
  • Phone: 757-439-2366
  • Fax: 757-693-9404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateVA

VIII. Authorized Official

Name: DR. EVAN FARMER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 757-439-2366